- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Specialist supports prospective risk adjustment via concurrent review and supplemental data ... CMS filing, HHS-Risk Adjustment Data Validation (RADV) audit and any other chart...Verifies accuracy, completeness, and appropriateness of diagnosis codes with provider partnerships based on medical documentation provided at all… more
- Fallon Health (Worcester, MA)
- … groups. + Identify diagnoses for submission as well as deletion in support of claims adjustment efforts + Ensure chart reviews and related claims ... patient charts for the purpose of validating regulatory Risk Adjustment scores. The Chart Review Specialist will...+ Collect documentation feedback and submit to Manager for provider education efforts + Update risk adjustment … more
- Zurich NA (Schaumburg, IL)
- General Liability Claims Specialist I 112465 At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it ... our General Liability team. As a General Liability (GL) Claims Specialist , you will work with a...develop and maintain strong relationships. + Understanding of the claims adjustment process and ability to determine… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …CLAIMS OPERATIONS Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist I must be in contact with personnel in other Units: ... Duties may include the following responsibilities or functions required to support the claims unit. Accurate processing of claims edits, determining primacy for… more
- City of New York (New York, NY)
- …identify, and report fraudulent claims , utilize statistical data to identify claims that pose potential risks, and provide risk management recommendations to ... employees serving in a permanent (not provisional) Civil Service title of Claim Specialist . To be considered for this position, PLEASE CLEARLY INDICATE YOUR CURRENT… more
- HUB International (Ellicott City, MD)
- …for report to insurer via Accord Notice or, to Warm Transfer / release insurer claims 800 line. + Provide follow up with claim acknowledgments and adjuster ... We currently have an opportunity for a **Claim Service Specialist ** to join our team in our **Ellicott City,...and commercial lines claims . + Proficiency with claims reporting, advocacy, status and reserve adjustment … more
- Providence (Mission Hills, CA)
- …with established policy guidelines. Reviews and authorizes payment and final disposition of claims requiring adjustment and claims benefit determination for ... **Description** Responsible for processing medical claims . Resolves complex, difficult or non-routine claims...career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace… more
- Motion Recruitment Partners (Alpharetta, GA)
- Provider Administration Specialist Alpharetta, GA **Hybrid** Contract $14/hr - $15/hr Exciting Provider Administration Specialist opportunity with an ... no more than two errors. + Knowledge of the company's claims processing systems, claims flows and adjustment notices. + Must be flexible to work any shift… more
- City of New York (New York, NY)
- …that impact the public fiscal and public safety. The Bureau of Law & Adjustment is responsible for investigating and adjusting claims filed for and against ... employees serving in a permanent (not provisional) civil service title of Claim Specialist . Please clearly state your permanent civil service title on your resume… more
- Federal Highway Administration (Lakewood, CO)
- …and requests for equitable adjustments. Responsibilities As a Civil Engineer (Highway - Claims Engineer), you will: Provide contract administration advice to the ... Branch, Supervisory Procurement Analyst and Acquisitions and Contract Branch Chief. Provide engineering expertise to Acquisition Contract Specialist in reviewing… more
- Aerotek (Tempe, AZ)
- …the Workers Compensation Compliance Supervisor and Workers Compensation Compliance Manager, the Claims Review Specialist will assist in the monitoring and ... **Overview:** **Aerotek has an immediate opening for a Junior Workers Compensation Specialist at the corporate office in Tempe, AZ.** **Job Summary:** Reporting to… more
- Robert Half Office Team (Minneapolis, MN)
- …employment opportunity in the Healthcare industry. This role is for a Retrieval Specialist who will be instrumental in enhancing the quality of our services through ... data collection and provider outreach. You will be a crucial part of...record requests * Perform medical record reviews for risk adjustment , HEDIS and HEDIS-like measures via remote EMR access… more
- Sedgwick (Columbus, OH)
- …to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Return-to-Work Specialist **PRIMARY PURPOSE** : To negotiate, facilitate and monitor successful ... Determines objective, quantifiable, medically supported work restrictions for assigned claims . + Facilitates return-to-work (RTW) efforts through negotiation with… more
- CareFirst (Baltimore, MD)
- …measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing, and claim ... incentive models. Strategizes alternatives and solutions to maximize payments and risk adjustment . Translates from claim language to services in an episode or… more
- Dialysis Clinic, Inc. (Nashville, TN)
- …during every patient interaction. We seek motivated, compassionate individuals to provide top-notch patient care and offer paid training, competitive pay, ... with a lower caregiver-to-patient ratio than other providers. **The Billing Specialist ** must have effective communications skills. This position requires a large… more
- Robert Half Office Team (St. Paul, MN)
- Description The Retrieval Specialist will play a vital role in the data collection cycle within Retrieval Operations, which focuses on risk adjustment and ... + Organize and manage various data sets using Excel spreadsheets. + Conduct claims research to determine the correct service location and/or verify member history. +… more
- Robert Half Accountemps (Minneapolis, MN)
- …during the month of November due to training. Position: Retrieval Specialist + Retrieval Operations integrates talented individuals with expertise and experience ... in many areas of risk adjustment and quality improvement, including HEDIS(R), CAHPS and Accreditation. Our goal is to achieve extraordinary performance that exceeds… more
- Aston Carter (Stockton, CA)
- …focuses on making an impact in your community? We are looking for a Billing Specialist to join the team! The Billing Specialist assists in maintaining the ... data entry to verify proper balancing/posting of payments to claims with accuracy and timeliness. . Runs reports that...use 10-key, ability to type 45 wpm, applicant to provide typing certificate. . Experience and knowledge of computerized… more
- RELX INC (Alpharetta, GA)
- …essential partner in the assessment of risk. Within our Insurance vertical, we provide customers with solutions and decision tools that combine public and industry ... Team LexisNexis Risk Solutions is seeking a Sr. Marketing Specialist to join our Insurance marketing organization. This is...driving marketing strategies and programs for the US Auto Claims team, as well as smaller cross-functional teams within… more
- MarketSource (Alpharetta, GA)
- 124282BRTitle:HR SpecialistJob Description:Human Resources Specialist MarketSource, an Allegis Group company, delivers integrated sales solutions by hiring, training ... space. MarketSource is headquartered in Alpharetta, GA. Summary The Human Resources Specialist is responsible for Human Resources related duties at the professional… more
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